Steroid joint injections
Your health expert: Dr Sundeept Bhalara, Consultant Rheumatologist
Content editor review by Pippa Coulter, December 2022
Next review due, December 2025
Steroid joint injections can reduce inflammation and ease pain in your joints. This allows you to move your joint more easily. You might have a steroid injection if you have a painful or swollen knee, hip, shoulder, elbow, hand or wrist.
About steroid joint injections
Steroid medicines are also known as corticosteroids. They are a type of medicine that work by reducing inflammation in your body. This helps if you have swelling and pain.
How steroid joint injections work
Steroid joint injections are injected directly into a painful or swollen joint, or into the soft tissue around it. Inside the joint, they act against substances that cause inflammation and damage your tissues. Having an injection into the injured area can also release pressure, which helps with pain and swelling.
There are several different steroid medicines that can be used for joint injections. These include hydrocortisone, methylprednisolone and triamcinolone. Methylprednisolone and triamcinolone are stronger than hydrocortisone.
Uses of steroid joint injections
Steroid injections can be used in many different conditions that affect your joints. These may include:
- rheumatoid arthritis
- other types of inflammatory arthritis – like psoriatic arthritis
- gout
- osteoarthritis
- tennis or golfer’s elbow
- carpal tunnel syndrome
- shoulder problems – like frozen shoulder or rotator cuff injury
Your doctor or other health professional may offer you a steroid joint injection if your joint pain has got worse, and other treatments aren’t helping. It can help as a short-term treatment to deal with severe pain, or while you wait to start longer-term treatment.
Where to get a steroid joint injection
Your GP may be able to give you a steroid injection at your local practice. Or a physiotherapist, rheumatologist, orthopaedic surgeon or nurse may do it in a clinic or hospital. Steroid joint injections can only be given by healthcare professionals who have been trained to do these procedures.
How steroid joint injections can help
Steroid joint injections may not cure the underlying problem or condition affecting your joint. But they may ease your symptoms. They’re often used alongside other treatments, such as other medicines and physiotherapy. If you’re having physiotherapy, steroid joint injections may allow you to cope with it better and get more out of it.
Some steroid injections start to work within a few hours and last for around a week. Others take up to a week to start working, but then last for a couple of months or more. Sometimes, depending on what’s caused the inflammation, the injection may be enough to completely fix the problem. You can have injections every three months if you need them. Generally, it’s best not to have more than three or four steroid joint injections per year into any one joint. This is because there’s a chance any more than that could damage your joint.
Preparation for a steroid joint injection
Your doctor or healthcare professional will discuss with you what to expect from having a steroid joint injection. If you’re unsure about anything, just ask. You’ll need to give your consent before having the injection, so it’s important to make sure you feel fully informed.
You should let the health professional doing your injection know if any of the following affect you.
- You take a medicine that thins your blood. This includes anticoagulants such as warfarin. These increase your risk of bleeding into the joint. You may need to have a blood test first to check how well your blood clots.
- You have a health condition that affects the way your blood clots, like haemophilia. This can also increase your risk of bleeding into the joint.
- You have diabetes. This is because a steroid joint injection may raise your blood sugar for several days afterwards.
- You have an allergy to steroids or local anaesthetic.
- You have a skin infection, or infection in the affected joint.
- You’re pregnant or breastfeeding. Steroid joint injections aren’t considered to be harmful if you’re pregnant or breastfeeding. But it’s still best to let the health professional know.
You don’t usually need to make any special preparations before having a steroid joint injection. But it’s best to wear comfortable clothes that allow easy access to the joint where you’re having the injection.
It can be difficult to drive straight after the injection. So it can be a good idea to arrange for friends or family to drive you home. Also, be prepared to rest the affected joint for up to a few days afterwards.
Having a steroid joint injection
The health professional carrying out the injection will examine your joint and clean your skin with an antiseptic.
You often have a local anaesthetic with a steroid injection. This stops any pain that you may have during the injection. Your doctor or healthcare professional may inject this into your skin before the steroid. Or, it may be mixed with the steroid in a single injection.
They will inject the medicines into the inflamed area of your joint. For certain joints, your doctor or healthcare professional may use ultrasound during the procedure to help guide the needle into the right spot. You may feel a tightness or pressure when you have the injection.
Sometimes, your doctor or health professional may remove (aspirate) any fluid in the joint during the same procedure. They will use a syringe to do this. It can make the joint more comfortable. This is most commonly done for swollen knees.
Aftercare following steroid joint injections
If you have a local anaesthetic, the pain in your joint will ease within a few minutes. The effects of the local anaesthetic may last for a couple of hours or sometimes more. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You may be asked to wait at the practice or clinic for a short time, to make sure you feel OK. This will usually only be for around 10 to 15 minutes if so. Once you feel ready, you’ll be able to go home. It’s usually best if a friend or family member can drive you home.
Recovering from a steroid joint injection
As the local anaesthetic wears off, the pain in your joint may initially be worse than before you had the injection. This pain is due to inflammation caused by the injection itself. It may last for a day or two. The following tips may help you manage the pain.
- Try putting ice or a cold compress on the area. This can reduce swelling and bruising. Don’t apply ice directly to your skin – always wrap it in a towel first. Only apply it for up to 20 minutes at a time.
- Take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.
- Rest your joint for a day or two at least. You should be careful not to do too much using the joint for the first couple of weeks.
It can take up to a week for the steroid injection to start working and easing your pain. Your health professional may give you some gentle exercises to do. You can slowly build these up as your symptoms improve.
Side-effects of steroid joint injections
Side-effects are the unwanted but mostly temporary effects you may get after having a treatment. Side-effects of steroid joint injections may include:
- Increased pain and swelling in the injected area. This usually settles within a couple of days. See the section on recovery for how to manage the pain.
- Feeling hot or having a flushed or red face. This usually happens straight after the injection, and goes away within a few hours. Occasionally, it may start the day after the injection and carry on for a few days.
- If you have periods, a steroid joint injection can temporarily affect them.
- Temporary problems with your blood sugar control if you have diabetes. It’s important to pay extra close attention to your blood sugar levels after a steroid injection if you have diabetes.
- Thinning or a change in the colour of your skin around the injection site. This tends to happen more often with stronger or repeated injections, and improves with time.
- Changes in your mood – you may feel very high or very low. This is more likely if you tend to get problems with your mood.
Complications of steroid joint injections
Complications are when problems occur during or after the procedure. Serious complications are rare with steroid joint injections. But they may include the following.
- An infection within the joint or in the tissues surrounding it. If the pain in your joint suddenly gets worse, or your joint feels hot as well as painful, seek urgent medical advice.
- Damage to your joint or tendons around it. This is more likely the more injections you have. This is why there is guidance around how often you can have steroid joint injections.
Ask your doctor or healthcare professional to explain how these risks may apply to you in your particular circumstances.
Alternatives to a steroid joint injection
If you can't have or don't want a steroid joint injection, there are other ways to manage your pain. What treatments you are offered will depend on your individual circumstances, including what’s causing your pain. They may include:
- steroid tablets
- anti-inflammatory and painkilling medicines
- physiotherapy
Ask your doctor about the options available to you.
This can depend on the underlying cause of your symptoms. Sometimes an injection can permanently stop your pain and inflammation. Other times, the injection may provide pain relief for a few days up to several months. This can be enough to help you take part in physiotherapy, or allow other treatments to begin working. See the About Section for more information.
You’ll need to leave a gap of at least three months between injections into the same joint. And it’s recommended that you should have no more than four injections into any one joint in a year. This is to prevent damage to your joint from the injection. You can find out more in the about section.
You should rest your joint for at least a couple of days after your injection. You may need to rest it for longer. It’s likely to be painful at first. Don’t do too much with the affected joint during the first couple of weeks. Find out more in the recovery section.
Corticosteroids
Osteoarthritis
Osteoarthritis is the most common form of arthritis, affecting over eight million people in the UK. It affects your joints, making them stiff and painful.
Rheumatoid arthritis
Rheumatoid arthritis is a condition which causes pain, swelling and stiffness in your joints.
Physiotherapy
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